Atypical Provider definition

Atypical Provider means an entity able to enroll as a billing provider (BP) or rendering provider for medical assistance programs related non-health care services but that does not meet the definition of health care provider for National Provider Identification (NPI) purposes.
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Atypical Provider means any provider assigned a covered provider type that ODJFS has determined is eligible to provide covered services that are non-health care services (i.e., those services that do not meet the definition of health care services in accordance with 45 C.F.R. 160.103 (2/2006)).
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Examples of Atypical Provider in a sentence

  • The Provider Enrollment Portal (PEP) Enrollment Steps – Atypical Provider Reference Guide includes enrollment application instructions and notifications applicable to providers wishing to enroll in the Puerto Rico Medicaid Program (PRMP) using the Provider Enrollment Portal (PEP).

  • Examples include taxi services, home and vehicle modifications, and respite services.The Enrollment Process for an Atypical Provider consists of multiple steps that must be completed in order to accept and submit an enrollment application.Each step is discussed in the following sections, including the panels and fields that must be completed.

  • Refer to the EDI Procedures Manual for more information about the outputs produced during EDI processing.All references to Medicaid are used for simplicity, but other programs supported by DMAS are also included, such as FAMIS and TDO.All encounters received will be processed using the NPI or Atypical Provider Identifier (API).Non-healthcare providers that are not eligible to obtain an NPI will receive a new 10-digit Virginia Medicaid Atypical Provider ID (API).

  • Populate with remittance number if payment is zero.TRN03Payer IdentifierPopulate with EIN ‘1056000622’SegmentREF Receiver IdentificationReferenceNameRhode Island RequirementsREF02Reference IdentificationPopulate with 7 digit Legacy ID if provider is associated with an NPI.Populate with FEIN if provider is not associated with an NPI (Atypical Provider).

  • The following data elements from the claim line item and EVV transaction must match:• Medicaid ID• Date of service• National Provider Identifier (NPI) or Atypical Provider Identifier (API)• Healthcare Common Procedure Coding System (HCPCS) code• HCPCS modifiers• Billed units to units on the visit transaction, if applicable Note: No unit match is performed on CDS EVV claims and unit match is not performed on visit transactions against the billed units on the claim line item for specific services.

  • For individuals residing in ALFs, adult foster homes, nursing facilities, facilities operated by the Department of Behavioral Health and Developmental Services or other institutional settings, record the name of the place, the approximate date of admission, and the National Provider Identifier (NPI) or the provider is unable to obtain an NPI, the provider will be assigned an Atypical Provider Identifier (API) by DMAS.

  • Examples of unique requirements for transactions to be sent to the health plan include, but may not be limited to:• Use of the ISA & IEA segments• Use of the GE & GS segments• Use of the Transaction Set Control Numbers (ST02, SE02)• Payer ID to be used• Instruction for use of zip codes (if any)• Instructions for Atypical Provider (if any)• Instructions for use of Taxonomy Codes (if they are required) Practices for Formatting, Acknowledging Receipt and Following Up on 837 Claims 1.

  • As such you will be assigned a ten digit Atypical Provider Identifier (API) for you to use when your application is approved.

  • Populate with remittance number if payment is zero.TRN03Payer IdentifierPopulate with EIN ‘1056000622’SegmentREF Receiver IdentificationReferenceNameRhode Island RequirementsREF02Reference IdentificationPopulate with 7-digit Legacy ID if provider is associated with an NPI.Populate with FEIN if provider is not associated with an NPI (Atypical Provider).

  • The application packet also includes an Electronic Funds Transfer (EFT) Agreement form that authorizes TMHP to deposit payments directly into a bank account, which results in faster payments.After the ITP application has been processed, the ITP will receive a letter from TMHP that includes the Atypical Provider Identifier (API) and the Taxonomy Code to be used when the ITP submits claim forms for mileage reimbursement.

Related to Atypical Provider

  • Medical provider means a medical service provider, a hospital, a medical clinic, or a vendor of medical services.

  • Professional Provider means a Physician, Dentist, Podiatrist, Psychologist, Chiropractor, Optometrist or any Provider designated by the Claim Administrator or another Blue Cross and/or Blue Shield Plan.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • Content Provider means any video programming provider of copyrighted works for transmission to Licensed Products and the copyright owners of such work.

  • Hub Provider means an entity that (i) provides Common Channel Signaling (SS7) connectivity between the networks of service providers that are not directly connected to each other; or (ii) provides third party database services such as LIDB. The SS7 messages received by Hub Providers are accepted or rejected by the Hub Provider depending on whether a contractual arrangement exists between the Hub Provider and the message originator (sender) and whether the message originator has contracted for the type of SS7 messages being submitted for transmission to the Hub Provider.

  • New Provider means any replacement service provider or providers engaged to provide the Services (or part thereof) or substantially similar services or the Authority itself where the Services or substantially similar services or part thereof continue to be provided by the Authority after partial termination, termination or expiry of this Contract;

  • Individual provider means an individual provider as defined

  • Data Provider means a Participant that is registered to provide information to GS1 South Africa for use through the Verified by GS1 Services.

  • Training provider means an organization meeting the eligibility conditions as mentioned in Data Sheet and selected in accordance with the criteria set forth for the purpose.

  • Participating Provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • Provider is any individual or company that provides professional or technical services.

  • Collateral Provider means the Security Collateral Provider under a Security Document or the Transferor under a Transfer Annex, according to context, in relation to which “Collateral Taker” means the Secured Party or the Transferee, as the case may be.

  • Data Providers means pricing vendors, analytics providers, brokers, dealers, investment managers, Authorized Persons, Subcustodians, Depositories and any other Person providing Market Data to the Custodian.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Financial Services Provider means any Lender and any other provider of financial services or products;

  • Services Provider means a provider of telecommunications services or other services similar to the Services, including O2 or an O2 Affiliate or any direct or indirect supplier of O2 or an O2 Affiliate;

  • Account Information Service Provider means a payment service provider pursuing business activities as referred to in point (8) of Annex I;

  • Participating Prosthetic Provider means a Prosthetic Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Third Party Provider means licensors, subcontractors and suppliers of BNYM furnishing the Third Party Products.

  • Child support services means any civil, criminal or administrative action taken by the Division of

  • Corporate Services Provider means Computershare Trust Company of Canada, a trust company formed under the laws of Canada, as corporate services provider to the Liquidation GP under the Corporate Services Agreement, together with any successor corporate services provider appointed from time to time;

  • Nonparticipating provider means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed health care system's provider network, but provides health care services to enrollees of programs authorized under this chapter or other applicable law whose health care services are provided by the managed health care system.

  • Providers means individuals or organizations --------- licensed to practice dentistry (including specialists) as well as other dental professionals who provide ancillary reimbursable dental services.

  • Technology provider means a person who:

  • Third Party Providers or “TPPs” means any payment service provider that provides payment services to you or someone else that concerns the Account, for example, an AISP (described in Clause 1(c) below).

  • Emergency medical services provider means a person who has received formal training in prehospital and emergency care, and is licensed to attend any person who is ill or injured or who has a disability. Police officers, firefighters, funeral home employees and other persons serving in a dual capacity one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of this chapter.